A typical daily diet for Kate looks like this:
All the water and sugar-free crystal light she can drink…, plus
B-fast: Peaches & Cream Oatmeal with Whole Milk; big handful of grapes; handful of Kix cereal
Snack: Full banana, Graham Cracker Sticks, Cheese Cubes
Lunch: Gerber Veggie Beef Dinner; Gerber Cubed Carrots
Snack: Gerber Apples and Cherries; Goldfish Crackers
Snack: Gerber Sweet Potatoes; Kix Cereal; Pear Juice
Dinner: Chicken Parmesan with Marinara, Mozzarella Cheese over Angel Hair; Steamed Peas
Snack: Full banana; two sips of very chocolately whole milk
These are all very generously portioned. And she cleans her plate. Plus, she is nursing before school, after school and at least once, usually twice, before bedtime. And nursing at least once during the night.
By my very conservative estimates, I think she is easily getting the approximately 1200 kcals she needs each day (the calculation is roughly 40 kcals per each inch of height… Kate is about 28 1/2 inches, I rounded up to 30). Actually, using the kcals I’ve estimated based on this diet, Kate is in excess of her caloric intake by up to a few hundred kcals per day.
But is she getting approximately 16g of protein? This is a very important question. Or maybe a better question, more to the point: is she getting ENOUGH protein to not have a protein deficiency in her diet?
I blogged earlier about my concerns over Kate. After speaking with the doctor on call and feeling ‘humored’ over exaggerated concerns for her health, (plus an incredibly busy few weeks), we didn’t pick up the urine bags and didn’t test her. It’s been bothering me, but I felt that since her next wellness exam was in the beginning of August that it was fine to wait. The doctor said I was really overly concerned and that she felt no reason to explore it further. Which made me take a step back and agree. After all, if something was REALLY wrong, one of her doctors would have noticed. Right? That question has been ringing in my ears. Am I missing something?
This morning, when I stopped in to say hello to Gladys, the baby room teacher, she told me that she had played with Kate yesterday and was very worried about her. Gladys said that Kate’s arms and legs were looking so puny and her skin seemed to just hang off of her — no real muscle. She was worried. Yes, I thought, I’ve noticed this, too, and haven’t liked it. Even more so, I’ve noticed her belly. Is it normal for a baby’s belly to be that round? Without signs of edema or other alarming things, I’ve been pushing these out of mind. But maybe the sight of kwashiorkor that comes to mind is too extreme… what would it look like in early stages, I wonder? But wait. If something was really, really, wrong (I keep telling myself) someone would have noticed. She’s been to the doctor twice in the past 2 months. Someone would have noticed!
Then, this afternoon, Gwen pulled me aside to voice the same concerns as Gladys. And she added a bit: Kate is not right. Yes, I thought, that is exactly it. Kate is not right. I know this. I’ve known this. She is not right. A child who eats as much as she does, who is always hungry, always eating… that child cannot look the way Kate looks. Kate easily eats three times what Will ate at this age and Will (although small) was definitely much larger than Kate.
I called Hales Pediatrics immediately when I got home. “Is this for a well-child or sick visit?” the receptionist asked. “I’m not sure,” I said. Dr. Oates will see us at 9:50 tomorrow.
In preparation for the appointment, I’ve written up two days of Kate’s diet and made notes about the last two months. Nothing in isolation seems unreasonable. Together, however, they worry me. I want Kate fully reviewed. Yes, she is making her milestones (and then some). She is eating — voraciously eating. But something is not right. I’m ashamed that I let the previous doctor embarrass me into backing down on my feeling a few weeks ago. This time it will not happen. I got the number for a back-up doctor that a friend recommended. Paul is coming with me. If Dr. Oates doesn’t see the need to explore Kate’s symptoms further, I am taking her for a second opinion, tomorrow if necessary.
Allen | 20-Jul-07 at 7:03 am | Permalink
Food & nutrition is one of our more constant concerns.
How active is she? You said a few days ago that she’s a “force of nature”, but is she running around and using her muscles, etc.?
Personally, I’d stay away from the sugar-free crystal light and use more milk (if she’s not lactose-intolerant or allergic). I’d stay away from the chocolate milk and use a few more fresh veggies and home-prepped stuff, and less Gerber. But that may not be possible with your schedules and/or care. And doesn’t sound like the root of the issues, anyway.
Shokufeh | 20-Jul-07 at 7:16 am | Permalink
It’s nice that you have such a relationship with her additional care takers, that they feel comfortable to express their concerns. And that they echo your own. Sometimes, as we muddle through motherhood, we need someone with more experience to tell us that our instincts are right. Don’t beat yourself up about it.
Good luck! I hope Kate’s okay.
Cold Spaghetti | 20-Jul-07 at 10:44 am | Permalink
If only it were as easy as changes in diet. Kate’s diet is quite perfect, given the circumstances (no ability to heat food at school, Kate having only 5 small teeth, and Kate’s refusal of milk). In lieu of juice, we’ve been giving her flavored water because we’ve found that she is more interested in milk (ie: will take more than one sip) if she is limited on her juice intake. Plus, I worry about the sugars in juice and her teeth, etc. Based on my calculations, Kate gets very well more than 16g of protein per day from food sources alone — often NOT including the additional 4-6g she gets nursing. I don’t remember the percentage of calories number off the top of my head, but it was well above the recommended 20% (I think it was just over 30%, which would make it perfect). When we were still vegetarians and Will’s blood was looked at (b/c Will was low on weight they tested just to be sure since we were vegetarians) — the doctors were surprised and impressed to find that his blood work showed him to be (their words) “the most nutritionally sound” child they had seen in a long time. By virtue of our history with Will’s health — and my training in maternal and child health nutrition (I taught a graduate course last fall where I graded therapeutic feeding programs and ration guides for mothers and children within refugee and IDP settings) I feel pretty on top of things in that regard.
So either we are missing something extreme that is causing her not to absorb nutrients properly, or something else is really wrong. Maybe she really is burning 250+ calories a day in all the work she does… she is VERY busy. Force of nature was no joke. But I’m having a hard time believing it.
I told Paul that we need to start feeding her straight fat. Gravy on everything, ice cream at every meal, rich creamy soups, etc. If she weren’t so small to begin with, this may not have even been an issue!
Allen | 21-Jul-07 at 4:29 am | Permalink
Best of luck!
Glad to hear the bloodwork, etc., all looks good.
Sounds like she needs to feed in the French Quarter. That diet would kill me, but it sounds like what she needs! 🙂